Despite Recent Decline in TB Cases CDC Cautions That Battle Against Disease Is Not Over
National TB Controllers Workshop Addresses TB Prevention and Control Efforts
The nation's state and big city tuberculosis (TB) controllers will convene at the Centers for Disease Control and Prevention (CDC) National TB Controllers' Workshop on September 5-7 at 8:30 a.m., at the Crowne Plaza Ravinia Hotel, to develop strategies to prevent a resurgence in TB cases and related drug-resistant TB. CDC announced a third consecutive yearly decline in U.S. TB cases for 1995, reflecting the effective use of resources for TB prevention and control. However, CDC officials caution against prematurely declaring a victory over TB for several serious reasons:
Drug-resistant TB is a continuing problem, with sporadic outbreaks of multidrug-resistant TB (MDR TB) being reported on a regular basis. Individual drug-resistant cases now occur in most of the nation. State TB control officials are modifying their recommended anti-TB treatment regimens to address these resistant strains, which require costly additional drugs and longer regimens to ensure cure and prevent further spread.
There have been sporadic reports of TB due to strain "W", which is an often deadly MDR TB strain involving resistance to several of the primary drugs used to treat TB. This strain was initially reported in New York City, and has now been reported in other areas of the country, most recently in the southeastern United States. During the meeting, CDC will request health departments to promptly report any TB cases due to this strain to ensure adequate treatment is provided for these patients.
A study of the nation's sickest MDR TB patients provides evidence that poorly administered treatment programs do more to foster the emergence of drug resistance than no treatment at all. One published study showed that an average of four mistakes per patient -- (1) inadequate initial regimens, (2) improper modifications of initial regimens, (3) insufficient drug susceptibility testing, and (4) failure to provide adherence promotion strategies -- have been made in the past; mistakes that could have been prevented. Also, further studies show that these mistakes may still be occurring.
Foreign-born TB cases increased 10.6% between 1992 and 1995, in contrast to a 24% decline in TB cases among U.S.-born persons observed during this time. CDC is presently enhancing efforts to prevent and control TB among foreign-born persons, which include conducting additional screening of new arrivals and directing intervention measures to immigrant populations at highest risk for TB.
TB had been known as a disease that primarily affects elderly persons; it is now increasingly seen in younger populations as well. During the last 10 years (1985 to 1995), there was a 3.0% increase in the number of reported cases nationwide. However, in children aged 0 to 14 there was a 23.6% increase.
Almost 23,000 cases are still reported annually in the United States, and 20 of the 50 states (40%) last year reported either no change or an increase in TB.
"This is not a time for celebration, but a time for cautious and guarded optimism," said Dr. Kenneth Castro, Director of CDC's Division of TB Elimination. Health officials are working with
CDC and health care providers across the United States to confront these new challenges. Dr. Castro noted that the decline in TB cases for the third consecutive year is primarily due to increased funding for state TB prevention and control programs, which translated into a reinvigoration of these programs. "The programs are developing and implementing effective activities such as recruiting and retaining skilled staff and improving laboratory capabilities for the prompt diagnosis of TB."
He added that "we need to continue and enhance collaborations with our international partners -- we as a global community can unite to fight this disease." CDC is currently conducting or participating in mutual projects in Vietnam, Manila, Mexico, Thailand, and Africa (Botswana, Uganda, and CÃ´te d'Ivoire).
The decline in U.S. TB cases clearly demonstrates that present activities have contributed to the numerous successes in the battle against TB and MDR TB. But the war is not over. "To eliminate this disease, efforts must be concentrated on sustaining current activities and ensuring that every TB patient has the best possible chance for a cure," said Dr. Castro.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES